Rajasthan patients launch campaign against hepatitis

Patients from various districts of  Thursday joined hands for creating an awareness programme to mobilise all stakeholders, including practitioners and policy makers, to combat the growing number of hepatitis cases.

As many as 12 million people may be chronically infected in India and most are unaware of it, experts say.

Lack of awareness about the disease and its treatment, coupled with the fact that it has no visible symptoms in its early stages, has contributed to its spread, particularly in northern India.

“Viral hepatitis is rapidly becoming an epidemic due to its long gestation period and the biggest contributing factor is insufficient knowledge and awareness among the general population,” said Ramesh Roop Rai, state convener of the National Liver Foundation, and a doctor at the Fortis Escorts Hospital.

“The virus can remain in the body for years without showing any symptoms of its presence, leading to more fatal consequences,” he said.

He laid particular emphasis on involving the families of patients as an effort to prevent disease transmission and patient care.

The National Liver Foundation (NLF) is a voluntary, non-profit organisation promoting awareness and prevention of liver diseases in India. It offers help, information, and supports to those suffering from liver disease and their families.

Bobby John, executive director of the Global Health Advocates India, said: “These diseases, being silent killers, have so far not attracted the attention of the policy makers.”

Global Health Advocates India is a non-governmental organisation that focuses on engaging all sections of society to fight diseases that disproportionately affect people living in poverty, and are also the leading causes of people living in poverty.

He said greater effort needs to be made to draw the attention of policy-makers and draw up a comprehensive policy towards addressing the issue.

 

This article has appeared in Business Standard on March 27 2014

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PATIENTS CAMPAIGN AGAINST VIRAL HEPATITIS REACHES RAJASTHAN AFTER SUCCESSFUL STINT IN GUJARAT, PUNJAB AND HARYANA

On the eve of the INASL (Indian National Association for the Study of the Liver) conference, patients call for a comprehensive approach, drawing attention to Hepatitis B and C disease- prevention efforts and treatment access.

Jaipur, March 27, 2014: Patients from various districts of Rajasthan and other parts of India today joined hands as a step towards building an awareness programme to mobilize all stakeholders- including practitioners and policy makers, to combat the growing number of Hepatitis infected people. 

As many as 12 million people may be chronically infected in India and most are unaware of it. According to experts, lack of awareness about the disease and its treatment, coupled with the fact that it has no visible symptoms in its early stages, has contributed to its spread; particularly, in northern India.

“Viral hepatitis is rapidly becoming an epidemic due to its long gestation period and the biggest contributing factor is insufficient knowledge and awareness among the general population. The virus can remain in the body for years without showing any symptoms of its presence, leading to more fatal consequences,” said Dr Ramesh Roop Rai, HOD Gastroenterology Fortis Escorts Hospital and former president of the Indian Society of Gastroenterology.

Citing an incident in 2010 that rocked the entire country when 20 Thalassemic children got HIV and Hepatitis C infection after blood transfusions at a government hospital in Jodhpur, he said, “When it comes to controlling the disease transmission, every newborn should be vaccinated. And for all those who haven’t been vaccinated yet, getting tested is pivotal. The HBV vaccination is still an option if test results are negative; otherwise, various treatment options are available to avoid further disease transmission.” He laid particular emphasis on involving the families of patients as an effort to prevent disease transmission and patient care.

According to Dr. Bobby John, Executive Director of Global Health Advocates (GHA) India, “These diseases, being silent killers, have so far not attracted the attention of the policy makers.” He said a greater effort to draw the attention of policy makers and draw up a comprehensive policy towards addressing the issue needs to be made. A disease can only be completely eradicated if the government strengthens competencies for diagnosis, treatment, care and follow-up of people infected with viral hepatitis”, Dr John said.

In December last year, a similar effort, drawing the need to formulate effective screening, prevention and control strategies was launched in Ahmedabad where National Liver Foundation launched its Gujarat Chapter. And in February patients from both Punjab and Haryana joined hands, voicing their concerns in accessing treatment options.

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Policy intervention, mass screening a must to curb liver cancer: Experts

Liver cancer a key focus area of discussions at Asian Pacific Association for the Study of Liver (APASL) 2014 in Brisbane

Leading medical experts from India and the Asia Pacific region have warned that without major changes to screening and treatment for chronic liver disease, the region risks losing its battle to contain a rapidly increasing cancer which is already the second leading cause of cancer deaths globally.

With a million new cancer cases being reported every year in India, doctors are of the opinion that cancers in the lung, stomach, liver, colon and breast contribute majorly to the estimated 500,000 deaths every year. According to WHO, the cancer related casualties in India is likely to rise to 700,000 by 2015.

According to Dr Bobby John, Executive Director of Global Health Advocates India, the increasing cases of liver cancer in the entire region, including India, was a key focus area of discussions during the recently concluded Asian Pacific Association for the Study of Liver (APASL) 2014 in Brisbane.

Liver cancer is the end stage of chronic liver disease, which includes diseases such as hepatitis B and C as well as non-alcoholic fatty liver disease (NAFLD).

In the Asia Pacific region it is estimated that 340 million people are affected by viral hepatitis alone and NAFLD, due to obesity, is becoming a key cause of chronic liver disease.

“The situation in India seems to be grim with an estimated 25-40 million people living with Hepatitis B and C,” said Dr Samir Shah, the Founder Trustee of National Liver Foundation (NLF) and Head of Department of Hepatology, Global Hospitals, Mumbai.

Both Dr John and Dr Shah had attended APASL and were part of the discussions with the medical community to chalk out realistic programmes to arrest the spread of liver diseases, particularly those caused due to the Hepatitis virus.

“Strategies to increase screening and treatment programmss in high-risk populations are urgently needed across the region, including India,” said Dr Shah, emphasising on the need for mass screening for liver diseases.

According to Dr John, without an effective screening protocol, measures to prevent the progression of liver disease and risk of liver cancer cannot be implemented.

Professor Amany Zekry, Chair of the Australian Liver Association said that with Hepatitis B and C infections, new treatments are offering exceptionally high rates of cure which will also help reduce the rates of liver scarring and hopefully, the burden of liver cancer. “Better treatment prevents transmission of the virus, but people with hepatitis need to be diagnosed and referred to engage with treatment. That’s an issue across the region and globally,” he said.

“Chronic liver disease is one of the biggest health issues in the Asia Pacific region. APASL 2014 was an opportunity to come together to encourage a more effective public policy response in prevention and access to services across the region,” Prof Zekry said.

 

This article appeared in Express Healthcare on March 24 2014

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Liver disease — an emerging epidemic in India

India needs more organ donors as liver disease is spreading like an epidemic with one in every five adults getting affected, experts said. In Mumbai alone, nearly 2000 patients die annually due to liver failure or liver cancer, while 300 patients are awaiting a liver transplant at any time, they said. Explaining the magnitude of the problem, Dr AS Soin, Chief Surgeon, Jupiter-Medanta Liver Transplant program, said one in five adults is suffering from liver disease.

‘If the current organ donation rate of around 2-3/million here is to become 10 times, it would equal with the one in developed West, and there would be sufficient donors for those on waiting list in Mumbai,’ Soin said in a statement here. Transplants can be life-saving or life changing. While kidney and pancreas transplants are life-changing, liver and heart transplants are life-saving, he said.

‘In kidney failure, dialysis can sustain life for several years, however, there is no such substitute in liver failure. Such patients do not survive unless they receive a liver transplant,’ said Dr Gautama Ramakanthan, Director of Transplant at Jupiter Hospital at a press conference. Senior transplant surgeon Dr R Mohanka said the cadaver donor rates in 2013 were 37/million in Spain, 24/million in the USA, 15/million in Chennai and 1.5/million in Mumbai.

‘This year, Chennai has had 12, Kochi 8, and Mumbai 6 cadaver donors’, he said. Jupiter Hospital CMD Dr Ajay Thakker said today’s function was organised at the insistence of liver recipients as the identity of the deceased don’t cannot be disclosed. ‘We have special protocols in place to ensure that patients on the cadaver wait list are medically, psychologically and financially ready to avoid wastage when a liver does become available’, Soin said. He said the success rate of cadaver as well as live donor liver transplantation is 95 per cent, Ramakanthan said.

 

The article appeared on March 5th, 2014 on health.in.com.

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Types & the Risk Factors of Hepatitis

“Hepatitis is the inflammation of the liver, which can be caused by toxins, certain drugs, heavy alcohol use and bacterial or viral infections,” explains Dr Bobby John. He is Executive Director at Global Health Advocates (GHA) who takes us through the types of hepatitis virus and the causes or risk factors of hepatitis.

Hepatitis A virus (HAV) is usually transmitted by the faecal-oral route, either through person-to-person contact or ingestion of contaminated food or water. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus.

Hepatitis B virus (HBV) is transmitted through exposure to infectious blood, semen and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth, or from family members to infants in early childhood. Transmission may also occur through unsafe sexual intercourse, transfusions of HBV-infected blood and blood products, contaminated injections during medical procedures, and sharing of needles and syringes among injecting drug users. HBV also poses a risk to healthcare workers who sustain accidental needle-stick injuries while caring for HBV-infected people. A safe and effective vaccine is available to prevent HBV infection.

Hepatitis C virus (HCV) is mostly transmitted through exposure to infectious blood. This may happen through transfusions of HCV-infected blood and blood products, contaminated injections during medical procedures, and sharing of needles and syringes among injecting drug users. Sexual or interfamilial transmission is also possible, but is much less common. There is no vaccine against HCV. Both HBV and HCV can cause cancer to humans.

Antiviral agents against HBV and HCV exist. Treatment of HBV infection has been shown to reduce the risk of developing liver cancer and death. HCV is generally considered to be a curable disease but for many people this is not the reality. Access to treatment remains a constraint in many parts of the world.

Hepatitis D virus (HDV) infections occur exclusively in persons infected with HBV. The dual infection of HDV and HBV can result in more serious disease and worse outcomes. The hepatitis B vaccine provides protection from HDV infection.

Hepatitis E virus (HEV), like HAV, is transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in the developing world and is increasingly recognised as an important cause of disease in developed countries. HEV infection is associated with increased morbidity and mortality in pregnant women and newborns.

From the Hepatitis family of viral infections, the most common and serious is the Hepatitis B & C virus (HBV & HCV).

Dr. Bobby John states that the risk factors for the contracting hepatitis include, “The HCV virus is transmitted through contaminated blood, medical equipment, including infected needles and through injecting drug use (IDU).[2] Being a relatively new virus first identified in 1989 and there is no vaccine for HCV yet.[3]”

“Most people who were infected long ago with HBV or HCV are unaware of their chronic infection or their high risk of developing severe chronic liver disease. Unknowingly they transmit the infection to other people. Hence, today, we are experiencing a silent epidemic. Additionally, the HCV being asymptomatic does not help detect it at an early stage.”

 

The article appeared in healthmeup.com on March 4th, 2014.

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Treating hepatitis co-infection in HIV affected is important: Expert

Co-infections of hepatitis viruses in HIV affected individuals is a major cause for concern and our medical experts should take cognizance of it, Prof. SP Thyagarajan, former vice-chancellor of Madras University and current Professor of Eminence & Dean (Research) at Sri Ramchandra University, Chennai.

“HIV cases should be screened for other viruses and a holistic treatment given to patients for a better quality life,” he said while delivering the eighth Professor JV Bhat Memorial Oration at School of Life Sciences, Manipal University here on Monday.

“Since most of the HIV-related mortality is due to these liver infections, and not necessarily from that of HIV, the experts should pay attention to the viruses as there is sufficient evidence to show they exist. All viruses should be taken into consideration together and treated appropriately. Because if HIV is treated and contained, the hepatitis viruses’ problem still remains,” said Professor Thyagarajan and added by doing so, the mortality rate can be reduced.

He spoke on the co-infection of HIV and the various forms of Hepatitis Virus (HBV, HCV etc.) in Indian population. A pioneer in this area of research, he gave an overview of the different facets of the HIV-HBV and HIV-HCV co-infections.

Backed by scientific data, he showed that co-infection of HIV-HCV was much more prevalent in the population than that of HIV-HBV co-infection.

He also pointed out that with advances in anti-retroviral therapy (ART) death due to HIV infections has been on the wane. However, most of the deaths that still occur are due to secondary or co-infections with liver diseases due to hepatitis virus co-infection being the most common cause. These can, with the help of available prognostic markers and treatment modalities, be altered with interactions between the clinicians and the diagnostic microbiologists.

The Prof. JV Bhat Memorial Oration is an initiative of the School of Life Sciences and Manipal University. Earlier, Prof. PM Gopinath welcomed the gathering. Dr H. Vinod Bhat, Pro-Vice-Chancellor of Manipal University in his presidential address recalled the humble beginnings of this oration lecture and marveled at the prestige and history that it has attained. He also highlighted the research and efforts of Prof. SP Thyagarajan in his pioneering research on HIV-Hepatitis co-infections, how he helped the community in treatment of such conditions and also his role in educating students at various levels.

The article appeared in The Times of India on March 3rd, 2014. 

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Liver Diseases: How to Prevent Viral Hepatitis Epidemic

Viral Hepatitis is the liver inflammation caused by one of the five hepatitis viruses, referred to as types A, B, C, D and E. Dr Bobby John, Executive Director at Global Health Advocates (GHA) explains that, while all of these viruses cause liver disease, they vary significantly in terms of epidemiology, natural history, prevention, diagnosis and treatment. Dr Bobby John points out ways we can prevent hepatitis.

Every year, about 4 million people or more contract HCV.[1] Over time, more than three quarters of infected individuals will develop chronic infection.[2] Today, an estimated 170 million people worldwide are living with chronic infection, which left untreated has significant public health consequences.[3]

In most countries, viral hepatitis is the leading cause of liver transplants, where such end-stage treatments are expensive and hence have limited treatment access. Chronic viral hepatitis also results in loss of productivity.

Who is prone to develop hepatitis?

Some groups are at more risk of contracting viral hepatitis than others. In communities where food and sanitation services are not optimal, hepatitis A and E tend to be more common. New hepatitis B and C infections are seen more often in recipients of organs, blood, and tissue, along with persons working or receiving care in health settings, and in vulnerable groups.

Viral Hepatitis Prevention:

Affordable measures, such as vaccination, safe blood supply, safe injections, and safe food, can reduce the transmission of viral hepatitis infections. Most of these measures not only reduce the transmission of viral hepatitis but also have spill over effects on the prevention of other infectious diseases. Furthermore, current therapies for hepatitis B and C give health care providers effective tools to combat the disease.

The best way to prevent Hepatitis B is by getting vaccinated. For adults, the Hepatitis B vaccine is given as a series of 3 shots over a period of 6 months. The entire series is needed for long-term protection. Booster doses are not currently recommended. Children need to be immunized along with the regular schedule of immunisation, currently along with the DPT vaccines at 6, 10 and 14 weeks post birth. In addition, it is imperative that all newborn children are given a single dose of the Hepatitis B vaccine at birth.

Hepatitis C is curable. In many instances, hepatitis C can be treated and cured using anti-viral medicines, but the disease remains under-treated worldwide for a lack of awareness about the disease and its treatment, coupled with the fact that it has no visible symptoms in its early stages.

Viral Hepatitis could be tackled with a co-ordinated mix of prevention, treatment and awareness programmes.

Reference:

[1] Mohd HK, et al. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology, 2013, 57:1333–1342.
[2] CDC. Hepatitis C Information for Health Professionals. May 2013.
Accessed at http://www.cdc.gov/hepatitis/HCV/index.htm on September 12, 2013.
[3] Mohd HK, et al. Hepatology. 2013.

 

The article was published on healthmeup.com on February 26th, 2014. 

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